Ampolitod vs. Top Ever Marine Management Phils. Inc.

A seafarer's illness not listed under Section 32-A of the 2010 POEA-SEC is disputably presumed work-related, but the seafarer must still prove by substantial evidence compliance with the conditions for compensability; however, only reasonable proof of work connection is required, not direct causation, and it is enough that the seafarer's employment contributed, even in a small degree, to the development of the disease. Furthermore, a company-designated physician's final medical assessment must not only be issued but also furnished to the seafarer within the 120/240-day period; absent such notice, the seafarer's disability is legally presumed permanent and total.

Rudy T. Ampolitod was hired by Top Ever Marine Management Phils., Inc., a manning agency, for and on behalf of its principal, TEMM Maritime Co., Ltd., as an Able-Bodied Seaman. He had been continuously rehired by respondents since 2009 in various positions—either as Ordinary Seaman or Able Seaman—aboard different vessels. His duties as an Able Seaman included overhauling and maintaining gears and equipment, as well as chipping rust and painting the deck, tasks that exposed him to industrial solvents, cleaning agents, and chemicals. The dispute concerns his entitlement to total and permanent disability benefits under the 2010 POEA-SEC after being diagnosed with Myelodysplastic Syndrome (MDS) following medical repatriation from the vessel "M/V" Coral Opal.

On June 27, 2015, Rudy T. Ampolitod was hired by Top Ever Marine Management Phils., Inc. for and on behalf of its principal, TEMM Maritime Co., Ltd., as an Able-Bodied Seaman aboard the vessel "M/V" Coral Opal for a period of nine months. Prior to this deployment, Ampolitod had been continuously rehired by respondents since November 2009 in various positions—either as Ordinary Seaman or Able Seaman—aboard different vessels. He was given a clean bill of health by the company-designated doctors before deployment.

On August 25, 2015, Ampolitod joined "M/V" Coral Opal. Sometime in October 2015, nearly two months after embarkation, he suddenly felt dizzy, weak, and tired. On October 22, 2015, he requested permission from the vessel's Master to undergo a medical examination at a clinic in Baton Rouge, Louisiana, for a complete blood count (CBC). The hematology results showed a platelet count of 51, well below the normal range of 150–400. Three days later, Ampolitod noticed bruising on his legs, arms, and other body parts, accompanied by dizziness and blurred vision. The vessel's Master sent him to West Jefferson Medical Center, where the attending physician diagnosed him with Thrombocytopenia, advised him to see a hematologist, and declared him unfit to work with a recommendation for repatriation.

On October 29, 2015, Ampolitod was medically repatriated and arrived in the Philippines the following day. On October 31, 2015, respondents had him admitted at Manila Doctors Hospital, where he was monitored and treated by the hematology team until November 21, 2015. The company-designated physician's impression was Pancytopenia Secondary to Idiopathic Thrombocytopenia Purpura, a condition compatible with Myelodysplastic Syndrome (MDS), as confirmed by a bone marrow biopsy on November 16, 2015. A cytogenetic analysis of Ampolitod's bone marrow specimen, conducted at the Molecular Cytogenetics Laboratory of St. Luke's Medical Center, yielded a report on December 10, 2015 showing no apparent chromosome abnormality, indicating that his illness was not genetic in nature. Respondents claimed that during medical history taking, Ampolitod admitted suffering from Isolated Anemia sometime in June 2015, though he was subsequently cleared for employment abroad.

Ampolitod's treatment began on October 31, 2015 and continued until May 2016, spanning nearly seven months. Sometime in May 2016, treatment was discontinued after his CBC reportedly showed normal results and he was declared fit to work. The company-designated physician nonetheless recommended that Ampolitod continue monitoring his CBC. Ampolitod thereafter regularly underwent CBC testing at Capitol University Medical Center in Cagayan de Oro, furnishing the company-designated physicians his results from January 20, 2016 until August 5, 2017. All results showed below-normal counts, particularly in platelets, and Ampolitod continued to suffer from dizziness, bruising, and blurred vision. During this period, Ampolitod also consulted Dr. Alisa Q. Queja, an internal medicine-hematologist, who in a Medical Certificate dated September 6, 2017 declared him "Not fit to work" under a diagnosis of MDS. Ampolitod further sought the opinion of Dr. May S. Donato-Tan, an internal medicine cardiologist at the Philippine Heart Center, who declared him permanently disabled.

On November 3, 2017, Ampolitod filed a complaint before the Labor Arbiter for recovery of permanent total disability benefits. During the mandatory conference, the parties agreed to refer the matter to a third doctor, Dr. Ivy Mae Escasa, an internal medicine-adult hematologist. In a Report dated January 25, 2018, Dr. Escasa confirmed Ampolitod's MDS, placed his survival at 8.8 years, noted a low risk of developing acute myeloid leukemia, and recommended that he no longer be allowed to work as a seafarer. The report, however, did not indicate that the illness was work-related. The Labor Arbiter ruled in favor of Ampolitod on March 23, 2018, concluding that his repeated and continuous rehiring exposed him to harmful chemicals in paints, solvents, and cleaning agents that caused his illness. The NLRC reversed the Labor Arbiter on August 28, 2018, finding that Ampolitod failed to prove a causal connection between his MDS and his work. The Court of Appeals affirmed the NLRC on November 28, 2019, holding that Ampolitod failed to show that his illness was contracted during his short stay onboard or that it was work-related.

• Work-Relatedness of Illness: Petitioner maintained that his MDS was caused or aggravated by his prolonged exposure to industrial solvents, cleaning agents, and chemicals containing benzene in the course of his duties as an Able Seaman, which included chipping rust and painting the deck.
• Invalidity of Final Disability Assessment: Petitioner argued that the supposed Final Disability Assessment dated January 20, 2016 was never furnished to him within the 120/240-day period; he only received a copy during the SEnA mandatory conference after filing the complaint in 2017.
• Continued Symptoms Despite Clearance: Petitioner asserted that he was made to monitor his CBC and received continued treatment until May 2016, and that his persistently below-normal blood count results contradicted the company-designated physician's declaration of fitness to work.

• No Disability Established: Respondents argued that Ampolitod had no disability as shown by the Final Disability Assessment issued by the company-designated physician on January 20, 2016, which purportedly declared him fit to work based on normal CBC results.
• Insufficient Exposure Period: Respondents asserted that only two months had elapsed between Ampolitod's deployment and the manifestation of symptoms onboard the vessel, and that long-term exposure to benzene is necessary to develop MDS, if at all.

• Review of Factual Findings: Whether the Supreme Court may review the factual findings of the NLRC as affirmed by the CA, given the general rule that Rule 45 is limited to questions of law.
• Work-Relatedness and Compensability: Whether Ampolitod's MDS is work-related and compensable under the 2010 POEA-SEC.
• Entitlement to Total and Permanent Disability Benefits: Whether Ampolitod is entitled to total and permanent disability benefits, notwithstanding the company-designated physician's supposed declaration of fitness to work.

• Review of Factual Findings: Yes. The conflicting factual findings between the Labor Arbiter and the NLRC, as affirmed by the CA, constitute a recognized exception to the general rule limiting Rule 45 review to questions of law, compelling the Court to examine the records.
• Work-Relatedness and Compensability: Yes. Ampolitod's MDS is work-related and compensable, his nearly six years of continuous reemployment having exposed him to benzene-containing chemicals that caused or contributed to the development of his illness; only reasonable proof of work connection is required, not direct causation.
• Entitlement to Total and Permanent Disability Benefits: Yes. The company-designated physician's final medical assessment was never furnished to Ampolitod within the 120/240-day period and was contradicted by his persistently abnormal blood counts, triggering the legal presumption of total and permanent disability.

• Review of Factual Findings: While Rule 45 is generally limited to questions of law and the NLRC's factual findings are accorded great weight and even finality when supported by substantial evidence, the Court recognized exceptions, including when lower tribunals have conflicting findings of fact. Here, the Labor Arbiter found Ampolitod's illness work-related and awarded benefits, while the NLRC, as affirmed by the CA, dismissed the complaint for failure to prove causal connection. This conflict compelled the Court to delve into the records and examine the questioned findings for itself.

• Work-Relatedness and Compensability: Under Section 20(A) of the 2010 POEA-SEC, disability is compensable when two elements concur: the illness must be work-related, and it must have existed during the term of the employment contract. MDS is not listed under Section 32-A as an occupational disease, and thus is disputably presumed work-related under Section 20(A)(4). This presumption, however, does not automatically grant compensation; the seafarer must still prove compliance with the four conditions for compensability under Section 32-A: (1) the work involves the described risks; (2) the disease was contracted as a result of exposure to those risks; (3) the disease was contracted within the period of exposure and under necessary factors; and (4) there was no notorious negligence. For non-occupational diseases, substantial evidence must show that the risk of contracting the illness was aggravated by working conditions; it is enough that employment contributed, even in a small degree. Only reasonable proof of work connection is required, not direct causation. Ampolitod's duties as an Able Seaman—chipping rust, painting the deck, overhauling equipment—exposed him to industrial solvents, cleaning agents, and chemicals containing benzene. Although symptoms manifested only two months into his latest contract, he had been continuously rehired by respondents for nearly six years performing essentially the same functions. Cytogenetic analysis confirmed his MDS was not genetic. The Court concluded it was highly probable that his prolonged exposure caused or contributed to the development or aggravation of his MDS.

• Entitlement to Total and Permanent Disability Benefits: Under the framework set forth in Elburg Shipmanagement Phils., Inc. vs. Quiogue, the company-designated physician must issue a final medical assessment within 120 days, extendable to 240 days with justification; failure to do so renders the disability permanent and total. The assessment must be final, definite, and conclusive, and must be furnished to the seafarer. In Gere vs. Anglo-Eastern Crew Management Phils., Inc., the Court held that the company-designated physician must not only "issue" but also "give" the assessment to the seafarer, who must be fully informed of their medical condition. Here, Ampolitod was never furnished a copy of the supposed Final Disability Assessment dated January 20, 2016 within the statutory period; he only received it during SEnA proceedings in 2017. Moreover, the assessment's credibility was seriously undermined by CBC results taken on and after January 20, 2016, all showing significantly below-normal platelet counts—consistent with thrombocytopenia, a symptom of MDS. The third doctor, Dr. Escasa, also confirmed low platelet count and mild anemia and recommended against allowing Ampolitod to work as a seafarer. In the absence of a valid final medical assessment furnished to the seafarer, the law presumes total and permanent disability. The grant does not require absolute helplessness; it suffices that the seafarer is unable to substantially pursue his gainful occupation without serious discomfort or pain and without material injury or danger to life. Attorney's fees of 10% were warranted under Article 2208(8) of the Civil Code, Ampolitod having been forced to litigate to protect his rights. Legal interest at 6% per annum was imposed from finality of the Decision until full payment.

• Disputable Presumption of Work-Relatedness (Section 20(A)(4), 2010 POEA-SEC) — Illnesses not listed under Section 32-A of the 2010 POEA-SEC are disputably presumed to be work-related. This presumption is limited to work-relatedness and does not extend to compensability. The seafarer must still prove by substantial evidence compliance with the conditions for compensability under Section 32-A, whether or not the employer disputes work-relatedness. Applied: Ampolitod's MDS, not listed under Section 32-A, was presumed work-related, but he still had to show that his working conditions caused or contributed to his illness.

• Conditions for Compensability (Section 32-A, 2010 POEA-SEC) — For an occupational disease and the resulting disability or death to be compensable, all of the following must be satisfied: (1) the seafarer's work must involve the risks described; (2) the disease was contracted as a result of exposure to the described risks; (3) the disease was contracted within a period of exposure and under such other factors necessary to contract it; and (4) there was no notorious negligence on the part of the seafarer. For non-occupational diseases, substantial evidence must show that the risk of contracting the illness was aggravated by the employee's working conditions. Only reasonable proof of work connection is required, not direct causation; it is enough that employment contributed, even in a small degree. Applied: Ampolitod's six years of continuous reemployment performing deck maintenance duties exposed him to benzene-containing chemicals, satisfying the conditions.

• 120/240-Day Rule for Final Medical Assessment (Elburg Shipmanagement Phils., Inc. vs. Quiogue) — The company-designated physician must issue a final medical assessment on the seafarer's disability grading within 120 days from the time the seafarer reported. Failure to do so without justifiable reason renders the disability permanent and total. With sufficient justification (e.g., need for further treatment or seafarer's uncooperativeness), the period extends to 240 days, with the employer bearing the burden of proving justification. Failure to issue the assessment within 240 days renders the disability permanent and total regardless of justification. The assessment must be final, definite, and conclusive. Applied: The company-designated physician's assessment was never furnished to Ampolitod within the statutory period.

• Duty to Furnish Final Medical Assessment to the Seafarer (Gere vs. Anglo-Eastern Crew Management Phils., Inc.) — The company-designated physician must not only "issue" a final medical assessment but also "give" it to the seafarer. The seafarer must be fully and properly informed of their medical condition, including examination results, treatments, diagnosis, prognosis, and disability grading. Absent proper notice, the seafarer cannot evaluate or contest the findings. Applied: Ampolitod never received the supposed Final Disability Assessment within the 120/240-day period, receiving it only during SEnA proceedings in 2017.

• "While the law disputably presumes an illness not found in Section 32-A to be also work-related, the seafarer must nevertheless still prove compliance with the conditions for compensability, whether or not the work-relatedness of his illness is disputed by the employer." — This passage articulates the critical distinction between the disputable presumption of work-relatedness and the separate requirement of proving compensability, a principle frequently tested in seafarer disability claims.

• "Only reasonable proof of work connection is required, and not direct causation. In resolving compensability, this Court only looks for probability, not the ultimate degree of certainty." — This formulation defines the evidentiary standard for work connection in seafarer disability cases, lowering the threshold from direct causation to reasonable probability.

• "the company designated physician must not only 'issue' a final medical assessment, but they also must 'give' their assessment to the seafarer concerned. The seafarer must be fully and properly informed of their medical condition." — This passage establishes the dual requirement of issuance and notification, ensuring that a final disability assessment is ineffectual unless actually communicated to the seafarer within the statutory period.

• "Accordingly, in the absence of a final, definite, and conclusive medical assessment by the company-designated physician furnished or relayed to respondent, the law steps in and presumes that respondent suffered total and permanent disability." — This statement defines the legal consequence of the employer's failure to furnish a valid final medical assessment, triggering the statutory presumption of permanent total disability.

• Elburg Shipmanagement Phils., Inc. vs. Quiogue, 765 Phil. 341 (2015) — Controlling precedent establishing the 120/240-day rule for the company-designated physician's final medical assessment and the consequences of failure to issue one within the prescribed periods. Followed and applied to hold that no valid final assessment was furnished to Ampolitod.

• Gere vs. Anglo-Eastern Crew Management Phils., Inc., 830 Phil. 695 (2018) — Followed for the doctrine that the company-designated physician must not only issue but also give the final medical assessment to the seafarer, who must be fully informed of their condition. Applied to invalidate the assessment never furnished to Ampolitod.

• Career Phils. Shipmanagement, Inc. vs. Tiquio, 853 Phil. 724 (2019) — Followed for the principle that the disputable presumption of work-relatedness does not signify automatic grant of compensation and does not extend to compensability.

• Grieg Philippines, Inc. vs. Gonzales, 814 Phil. 965 (2017) — Cited for the recognition that benzene is a widely used chemical in making plastics, lubricants, rubbers, dyes, detergents, drugs, and pesticides, supporting the finding that Ampolitod was exposed to benzene in his deck maintenance duties.

• Abella vs. Abosta Shipmanagement Corp., G.R. No. 249358, April 28, 2021 — Followed for the requirement that the company-designated physician's medical assessment must be final, definite, and conclusive, and for the presumption of total and permanent disability in the absence of such assessment.

• Section 20(A), 2010 POEA-SEC — Governs a seafarer's entitlement to disability benefits, requiring that the illness be work-related and that it existed during the term of the employment contract. Section 20(A)(4) provides that illnesses not listed in Section 32 are disputably presumed work-related. Applied to determine Ampolitod's entitlement to disability benefits.

• Section 32-A, 2010 POEA-SEC — Lists occupational diseases and sets the four conditions for compensability: (1) the seafarer's work involves the described risks; (2) the disease was contracted as a result of exposure; (3) the disease was contracted within the period of exposure and under necessary factors; and (4) no notorious negligence by the seafarer. Applied to evaluate whether Ampolitod's MDS, though not listed, met the conditions for compensability.

• Article 2208(8), Civil Code of the Philippines — Authorizes recovery of attorney's fees in actions for recovery of wages of laborers and actions for indemnity under employer's liability laws, and where a party is forced to litigate to protect their rights. Applied to award 10% attorney's fees to Ampolitod.

Inting, Dimaampao, and Singh, JJ., concurred. Caguioa (Chairperson), J., filed a concurring and dissenting opinion, the contents of which are not reproduced in the provided text.

N/A — The text identifies that Caguioa, J. (Chairperson) filed a concurring and dissenting opinion, but the substance of that opinion is not included in the provided case text.